– Bhavna Pandey
The internship had just begun, and I was excited to start with medicine. Fortunate to be posted with a supportive team and mentors to guide me, I was placed in charge of the medicine ICU—unaware that I would soon be managing it all alone at night while on duty. It was only my first weekend, and already I was scheduled for a double night duty.
A typical day in the medicine ICU begins at 7:30 a.m., reporting for work with the postgraduate resident (PG) already waiting at the bedside. I rushed in with a blank sheet to record vitals, collected reports of investigations sent the previous night, and checked drug charts—assisting the PG with documentation before the senior consultant arrived. Just when there seemed a moment to pause, rounds began, and I found myself constantly on the move, sometimes clueless but busy finishing assigned tasks.
The hours blurred into raising investigations, sending samples, completing discharges, and counselling attenders. Yet all this effort carried meaning when I saw a patient improve. Witnessing the journey of a patient—shifted from the emergency in critical condition, stabilised in the ICU, and eventually recovering enough to move to the ward—was profoundly satisfying. That experience gave me the willpower to endure the night duties ahead.
My duty began on Saturday morning. After a quick breakfast—I knew breaks would be unpredictable—I reported to the ICU. On duty days, we were also required to attend outpatient clinics (OPDs), which I usually enjoyed. But this was my first medicine OPD as a non-local, with little command over the regional language, and I was expected to manage patient complaints independently.
I started slowly, taking a detailed history from my first patient. I was hesitant to gather the courage to present it to my PG or consultant sitting beside me, though they were encouraging. I was scolded for being slow, but I still felt proud: that day, for the first time, I had independently addressed patient concerns. I saw six cases, contributing my small share in wrapping up the OPD.
After a quick lunch, I relieved my co-intern in the ICU, only to face a mountain of pending tasks. Once immersed in work, fatigue seemed to recede, and I attended to each patient with attention. Amidst the workload, I also had the chance to assist in a central venous line insertion—an exhilarating experience indeed.
Just twelve hours in, I already longed to crawl into bed, but the night duty left no room for rest.
As the day ended, fellow interns from other units handed over their patients, leaving my co-intern and me with 12–15 patients to monitor overnight. When unfamiliar with a patient’s details, we relied on the instructions in the handover book. We began with routine tasks—sending blood samples, ensuring nursing staff administered treatments, and recording hourly vitals for the most critical cases. Suddenly, my senior asked me to fetch a narcotic agent for a restless patient. That night I learned the entire protocol: the paperwork, signatures, and consent required. After four trips across the corridors, I finally returned with the drug, and we were able to ventilate the patient effectively. From that day, I became adept at procuring medications through the proper channels—earning the nickname “smuggler” from colleagues, in jest.
I volunteered to rest during the first half of the night, though much of that time was wasted adjusting the fan speed. At 3 a.m., my phone rang—I was up to relieve my co-intern. I sat by a patient undergoing a blood transfusion, monitoring vitals, before joining my senior. She taught me topics in cardiology, and we shared a lively discussion on murmurs. That unexpected tutorial at such an early hour left me oddly delighted.
At 6 a.m. sharp, it was time to begin arterial blood gases (ABGs)collection for all patients. Despite multiple attempts, I managed only a few drops—insufficient for analysis—but at least I learned the procedure. Before my PG arrived, I rechecked vitals and asked patients if they had new complaints. Many ICU patients, bound by tubes, could not speak, yet their eyes spoke volumes. Even without sharing a language, I felt connected while holding their pulse. Communication came more easily in the wards, once I had gained fluency in the local language—a skill that pushed me daily to go to the wards early.
If all tasks were completed and ABG reports were ready, interns were usually permitted a short break. That morning, I was allowed to freshen up and eat, though there was no time for sleep before rounds. Rounds brought fresh tasks and new lessons. That day, I learned how to adjust ventilator settings in preparation for extubation—a critical skill.
It was Sunday, and as often happens, every other unit was eager to leave early, leaving much of the workload to interns on duty—unfortunately or not, but once again, me. Despite an early handover, the volume of work did not lessen. I felt dizzy, craving sleep, yet the patients still required constant attention.
We followed the routine drill—completing tasks, grabbing a short break, and preparing for another night. Even a ten-minute nap worked wonders, and after dinner, I managed a brief rest before resuming. All samples were sent, and a blood transfusion was planned for that night.
By 11 p.m., most tasks were finished. As I was assigned the second half for rest, I found myself monitoring patients between ventilators and chatting with a friend on call to stay awake. To survive the night, my PG and I exchanged lighthearted banter until around 2 a.m., when a nurse requested blood for a patient. I boarded the patient transport van, enjoying the cool breeze during the short ride to the blood bank in the adjacent building. There was no fear—only a sense of responsibility keeping me alert.
The transfusion began upon my return, and I asked my co-intern to follow up while I rested. The morning routine remained unchanged, though this time I felt refreshed from an hour of uninterrupted sleep. ABGs were done. Exhausted by two continuous night duties, I longed for a break. My mind felt numb, and I asked my PG to give written instructions, since verbal ones did not quite register in my fatigued brain.
I felt relieved to have survived two consecutive night duties, though the final 10–12 hours before I could finally change into my nightclothes stretched endlessly. My mind was clouded with fatigue, but eventually I witnessed, learned, and grew.
These 60 hours taught me a lesson that medicine is not about surviving shifts but standing witness to the resilience of both ours and the patients.